Only the size of your fist, the kidney is the most complex filtering system that exists on earth. It has the ability to take up to 200 quarts of blood daily and sort out water, electrolytes, and toxic waste (“National Kidney and Urologic Diseases Information Clearinghouse”). At the same time, it can remove about two quarts of these chemicals, thus maintaining homeostasis in the body (“National Kidney and Urologic Diseases Information Clearinghouse”). Three days without these beaned shaped organs and you would not exist. Fortunately, we have some solutions to this problem. This is what we will be investigating: what happens in Honduras when these kidneys fail, and what can be done for the people who have this problem.

CKF

CKF, or chronic kidney failure, is when your kidney function drops to below 15% of their normal function. Then, once it is below 15%, you most start hemodialysis in order to keep on living. Your kidneys do not "dry out" because blood still travels through them. But the nephrons do not function anymore due to either trauma or a chemical that has prevented them from working anymore. If chemical toxins were involved, they are left in the body until dialysis is started. The kidneys no longer function and

therefore no urine is produced to remove this waste.

In order to do hemodialysis you most have a port to draw blood from and return the cleansed blood to the body. Usually the patient starts with one that is directly connected to the heart. Since the catheter goes directly to the heart, even a small infection could be life threatening.

The danger of this happening is great, so the doctors change the port to an arm as soon as it is ready for the wear and tear of needles being stuck into it every other day. Doctors do this so the patient has time to do exercises with that arm so the veins are strong.

In Honduras it is a difficult procedure to “install” one of these ports, as the hospital is a public hospital and always very busy. Kids could be waiting for up to five days with no idea of when there will be a doctor who can do the surgery for them. The wait is difficult for the patients because they cannot eat during this time -so that they are always ready for the OR. Even to be eligible for this procedure your family must donate two units of blood, prior to the surgery. They do this instead of making you pay. Giving the blood can be difficult when you can only do it early in the morning and you need it as soon as possible, in order to stand a better chance of getting on the schedule for the OR.

Restrictions on eating are necessary measures for dialysis patients, since our kidneys normally cleanse out great amounts of sodium and potassium in a single day. The potassium levels constantly rise as you consume more fruit, avocados, cheese, and various other foods. Sticking to a diet in Honduras and eating health is not easy as two-thirds of the total population lives in poverty (“Honduras”). Cheese is high in sodium and that is one of Honduras’s favorite sides with half of their food, mainly because it is cheap and it fills you. Staying away from fruit is hard for anyone that lives there: the country has such

great bananas, pineapple, and mangos. To make it easier in dialysis, patients are only allowed to drink eight ounces of water a day and they have to drink most of it just to swallow their pills.

This disease can ruin a patient’s chance of a typical life in Honduras because there is only one hospital for pediatric hemodialysis: that is found in the capital of Honduras. With cars not being extremely common, it makes it to where some have to move to the capital, or travel for hours every other day to make it to hemodialysis. If the kids come from far and the parents do not come with them regularly, the doctors have the authority to take the kids away from their parents and place them in a fostering center. For parents it is hard to come with their child every time, as the parents have jobs or are single parents with many other children that they have to take care of. By the time a patient has been on dialysis for a year, they know which bus to take and where to go better than anyone else, given that the kid is older than twelve years.

Who Is Affected?

Like all health problems there are factors that contribute as to who might be affected. One of the major factors is the lack of purified water. In some areas, where it is extremely hot, this becomes a very serious problem, especially when people work in the fields all day and are not hydrated. Since Honduras grows a lot of bananas and coffee, it takes no small amount of farmers to do the labor. These are the people that are more likely to be affected by end stage kidney failure. As they do not drink enough water, the toxins quickly accumulate in the body damaging the kidneys. An anthropologist summarizes it as this:

The roots of the epidemic' appear to lie in the grueling nature of the work performed by its victims, including construction workers, miners and others who labor hour after hour without enough water in blazing temperatures, pushing their bodies through repeated bouts of extreme dehydration and heat stress for years on end. Many start as young as 10. The punishing routine appears to be a key part of some previously unknown trigger of chronic kidney disease, which is normally caused by diabetes and high-blood pressure, maladies absent in most of the patients in Central America. (S.R.N.)

Coke also contributes as a problem. As people do not have clean running water in their homes, they drink lots of Coca-Cola that is sold in most neighborhoods. "One soda per day increases your risk of diabetes by 85 percent" (Mercola). Since diabetes is a leading cause to kidney failure, it is scary to think that a lot of Hondurans drink a Coca-Cola a day. All this to say that 4.67% of all deaths were caused be renal disease in Honduras in 2011 ("Honduras: Kidney Disease."). That is almost one in every twenty people that die from it! This puts Honduras as one of the top ten countries with the highest mortality rates from kidney disease (Rubio).

What Can Be Done For Them?

As mentioned, a patient must live on hemodialysis in order to keep on living, usually three times a week at the public hospital. Dialysis cleans their blood a maximum of two days, given that they are sticking to their diet. They live in hope that someday they can have the kidney transplant procedure so that they can stop surviving on dialysis. Finding a donor is not easy, as Honduras does not have the money for anti-rejection medications; instead, they have to find a relative that is a very close

match to their own kidney. In the USA the cost for a kidney transplant is $90,000 dollars the first year than $16,000 dollars every following year for anti-rejection medicines (Stam 206). The hospital tries to provide the surgery for free, but oftentimes they fall short on pain medications needed after the surgery, which you must purchase. $16,000 a year for pain meds is way too much for the country to afford; accordingly, they do not even have it for sale in the country. It often takes more than five years for the doctors to find the right person to give a kidney transplant, to do all of the tests to make sure they are a match, and then for the doctors to actually do the procedure. This is not good, as a stage 5 kidney failure survival rate is 75% the first year, then 50% the next two years, then 34% at five years, and only 17.6% at ten years (Molzahn 197).

After the kidney transplant, the patient must live close to the hospital and live in a house that is very clean, and live with only one person to help them for two months. The doctors have to keep on checking the patient to make sure that the body has not rejected the kidney. To insure that the kidneys are working and to keep them busy, the doctors make the patient drink two gallons of water each day. For only one out of eight of the transplanted patients, does the kidney work after the first year, even with all of those procedures.

Life in the Hospital

Hospital Escuela (the public teaching hospital) is the place where the pediatric patients receive most of their health care for kidney failure. It is the biggest public hospital in the country, and is the only place where Hondurans can get cheap healthcare for most of their problems. The renal unit

consists of three wards for patients who are hospitalized. Each ward can hold ten kids and enough chairs to hold ten parents. In the renal unit there is only one private room used for patients that are either feeling really sick or for a patient who has received a transplant. The hospital has harsh rules about visiting hours for parents: they do not like parents to be there when the doctor is making rounds with the residents, and they do not let parents stay the night with their children unless it is an emergency. The food is also a hard thing to deal with. The nurses sometimes give the kids mashed potatoes and cheese and food that is high in potassium, even though they are not supposed to eat it. They do this because it is the only food that they have. The kids have a T.V. they share in the room, but usually it is playing soap operas that the parents like to watch. Sometimes they will play games with each other, but most have not played very many card games so it becomes a bit of a challenge to teach them some games. When in the hospital, patients seem to get depressed, which does not have a good effect on their health. They have to keep up their morale if they want to have a chance of being released to go home until they are called into dialysis again. During the night there is usually one nurse on duty, and sometimes there will be a resident there also when the ward is congested.

In the small room where the hemodialysis takes place, there are four dialysis machines with four recliners and a nurse and a dialysis machine technician. The patient sits and the nurses connect two catheters into them: one to draw out the blood and the other to return the clean blood. On the wall there is a T.V. so the patients can pass by those painful hours. There, patients spend four hours every other day, except on weekends. One crazy thing is that on the week of Easter the only nurses that can do dialysis get the week off. If you are a patient that means you will be going a whole week without dialysis.

The Future Is Still Undecided For Them

Honduras is still a third world country. Hopefully, as it develops more, it will be able to take better care of these patients that live on a machine. The country still needs the money for medicine to give to these patients. Pediatric Nephrologists are not very many: in the whole country there are only three, one of which is a private doctor. More dialysis machines would come in handy. As for the pediatric patients, there are only four machines in one location. Dialysis centers are also a great need throughout the country, so they are more accessible to people and so that they do not have to live in the capital. If they do not receive these needs, kids will continue the grueling trip to the capital to life on a dialysis machine in hope that someday doctors will have time to do the screening necessary, in order to put them on the transplant list. Even if they do get the needed transplant, who knows if their bodies will accept the foreign kidney without the proper anti-rejection meds?